Abstract
Background:
Mpox was declared a Public Health Emergency of International Concern by the World Health Organization in August 2024, following an outbreak in Africa. Public engagement on YouTube provides insights into public perceptions during such crises.
Objectives:
We analyzed public discourse and sentiments related to Mpox, focusing on thematic trends in YouTube comments.
Design:
A qualitative synthesis employing thematic content analysis of YouTube comments.
Methods:
The YouTube API retrieved 50 videos each for “Mpox” and “Monkeypox.” After exclusions, 50 relevant videos remained, and the top 10 by views were analyzed. From 10,567 comments extracted, 2826 were analyzed using Latent Dirichlet Allocation modeling to identify themes.
Results:
Key themes included geopolitical concerns, disease spread, conspiracy theories, public health measures, and religious interpretations. Comments revealed mixed views on vaccines, lockdowns, and mistrust in authorities.
Conclusion:
Effective health communication must address scientific, cultural, and geopolitical dimensions while countering misinformation and fostering trust.
Introduction
Mpox, previously known as monkeypox, is a zoonotic disease that has garnered substantial attention due to its rapid spread and global health implications. On July 23rd, 2022, the World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern (PHEIC). Approximately a year later, the end of this global public health emergency for Mpox was announced. 1 Yet again, on 14th August 2024, the WHO declared the latest Mpox outbreak in Africa a PHEIC. 2 Understanding public perception and engagement on Mpox on digital platforms is crucial for effective health communication and response especially in the heights of health emergencies. In this study, we aimed to analyze public discourse and sentiments related to Mpox, focusing on thematic trends in YouTube comments.
Materials and methods
We identified videos with the search terms “Mpox” and “Monkeypox” using a YouTube API in R-Studio. The API returned 50 videos for each term, sorted by YouTube’s default “relevance” ranking. We excluded 9 duplicates and 41 videos uploaded before August 14, 2024. The remaining 50 videos were ranked by view count, and the top 10 most-viewed videos were selected for detailed analysis. This process ensured that the analyzed videos represented highly engaged content relevant to the Mpox outbreak during the study period. We then retrieved 10,567 comments from these top 10 most-viewed videos on August 18, 2024. Comments were extracted using the YouTube API and processed in R-Studio. After conducting text normalization and tokenization, 2826 meaningful comments remained. A Document-Term Matrix was created, and a 20-topic Latent Dirichlet Allocation model was applied. For each topic, we identified top terms with the highest beta values and then determined overarching themes and subthemes. These themes were refined based on relevance and frequency. The percentage distribution of each theme was calculated, and subthemes were analyzed to capture public discourse. Example comments were selected based on their alignment with identified themes and subthemes, emphasizing comments that covered prevalent sentiments. These were cross-checked with thematic trends to ensure they were representative of public discourse. Thematic content analysis revealed several themes and subthemes. We followed the STROBE guidelines in the reporting of this study. 3 No ethical review was required since no human subjects were involved.
Results
From the qualitative synthesis of the top 10 most-viewed videos, 5 major themes emerged.
Geopolitical and cultural context
The Borders and Travel subtheme, which captures concerns about travel restrictions and border controls, was noticeable. One user noted “You haven’t closed the borders with Africa, the epicenter of the disease? You let them travel? Well, let the infected migrants come in swarms. You’re responsible for open borders.” While another expressed concerns “This is not the time for lockdowns and border closures, I’m traveling next month (and not to south central Africa where this disease is wreaking havoc).” The Regional Focus subtheme reflected discussions centered on regional aspects of the outbreak, in most instances, Africa was mentioned as it is the “epicenter.” One user tried to clarify “For all of those conspiracies theorists Mpox has been a problem for a long time in the Congo and they have been outbreaks in Africa and Europe but those aren’t covered in international media unless it significantly worsens and spreads to other mostly an American Asian or European state.”
Mpox and disease spread
Within this theme, the Disease Transmission subtheme was discussed. A user stated “It’s common sense to contain this before it spreads! Stop the boats and the flights! No sign of lessons learned whatsoever. Closing borders won’t work? How do they come to that conclusion! Unbelievable!.” The Global Impact subtheme, addressing the broader implications of the outbreak, was also a focus of several users one noting general fear “This is scary. People who get Mpox might have a huge influence in the world. It’s contagious.”
Public figures and conspiracy theories
The conspiracy theories subtheme, which includes comments about unfounded claims and conspiracies, was highly prevalent. In addition, the Misinformation subtheme, covering false information and misleading narratives, also emerged while for the Influence of Public Figures subtheme, users discussed the role of notable individuals in shaping public perceptions. “They want us to be house arrested again. They keep telling us of more severe viruses that will affect millions. The only things they aren’t telling us are that they desperately want to reduce most of us and leave small manageable numbers of people who can be governed by one elite group acting as our god.” “The word ‘Liar’; can also be defined. We are tired of your lies, I will not comply, and I don’t believe or trust the WHO same as some media houses.”
Public health measures
Lockdowns and Restrictions subtheme discussed the impact and reactions to lockdowns, a user strictly noting “Can things get any worse? If a new lockdown ever comes into force, it will be even more damaging than the ones for Covid-19.” The Vaccination subtheme reflected debates and opinions on vaccination, while Preparedness and Readiness was also an emerging subtheme. Someone stated “I hope they have a vaccine ready with loads of boosters. . . I’m sitting here with my sleeve rolled up in preparation. Save me!!!! I want the juice right now!!!!” “Big pharma, please make Mpox vaccine and booster ASAP.” The Public Health Measures theme overall comprised 10.76% of the comments.
Religious and spiritual interpretations
This theme encompasses religious and spiritual perspectives on the outbreak. The Divine Punishment or Testing subtheme was overwhelmingly prominent, reflecting a strong belief among commenters that the outbreak was a form of divine retribution or test. A commenter noted that “. . .the world, the gods, the universe or whoever is in charge of history repeating itself has got this whole decade messed up!” The Faith-Based Responses subtheme includes discussions on religious responses and prayer related to the message, “In the name of Jesus Christ you won’t keep humanity captive again. The Lord rebuke you and may His judgment be unleashed on all you evil doers that spread fear, liars that causes confusion. Overall, the Religious and Spiritual Interpretations theme represented 15.89% of the comments.
Discussion
In this analysis, we highlight the critical role digital platforms play in reflecting and amplifying public sentiment during global health crises. 4 The focus on borders, travel, and regional issues emphasizes the global nature of Mpox and public concerns about its international spread. 5 The discussion around Africa, often labeled as the “epicenter,” reflects both awareness and underlying biases. Public health messaging must address not only the medical aspects of the outbreak but also geopolitical fears and prejudices. 6 The public’s apprehension about containment measures suggests a perceived vulnerability and a demand for more stringent actions, drawing lessons from the COVID-19 pandemic. Mistrust toward authorities and influential individuals, reflected in the predominance of conspiracy theories, highlights the challenges faced by public health communicators. The association of figures of renowned scientists and philanthropists involved in public health research and interventions features broader skepticism toward global health initiatives, emphasizing the importance of transparent communication and proactive countering of misinformation.
Mixed opinions toward lockdown and vaccination were common. While some comments supported vaccinations, others expressed concern over the potential negative consequences of lockdowns, shaped by past COVID-19 experiences. 7 This suggests a gap in public engagement with health interventions, which could impact their effectiveness. The strong divine belief indicates that religious interpretations remain influential in public discourse emphasizing the need for culturally sensitive communication while promoting evidence-based health information.
However, this study has several limitations. First, YouTube comments may not represent the full spectrum of public opinion, as platform engagement varies across demographic groups, potentially introducing bias. Second, the selection of the top 10 most-viewed videos emphasizes content with high visibility but might overlook other significant videos with lower view counts. In addition, the reliance on comment analysis could exclude perspectives from viewers who did not comment. These limitations show the importance of interpreting our findings within the context of YouTube’s user base and engagement trends.
Conclusion
Amidst the ongoing Mpox outbreak, public health communication must be holistic, addressing not only the scientific and medical aspects of the outbreak but also the geopolitical, cultural, and religious dimensions that shape public perceptions.
Supplemental Material
sj-docx-1-tai-10.1177_20499361251323709 – Supplemental material for WHO declares Mpox a public health emergency: “you haven’t closed borders with Africa, the epicenter?”—YouTube reactions highlight geopolitical tensions
Supplemental material, sj-docx-1-tai-10.1177_20499361251323709 for WHO declares Mpox a public health emergency: “you haven’t closed borders with Africa, the epicenter?”—YouTube reactions highlight geopolitical tensions by Ivaan Pitua and Felix Bongomin in Therapeutic Advances in Infectious Disease
Footnotes
References
Supplementary Material
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